Rhode Island Severe Mental Illness Information, Laws, & Helpful Resources

R.I. GEN. LAWS § 40.1-5-7 (a) Applicants. Any physician or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 who, after examining a person, has reason to believe that the person is in need of immediate care and treatment, and is one whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of psychiatric disability, may apply to a facility for the emergency certification of the person. The medical director, or any other physician, or a licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 employed by the proposed facility for certification, may apply under this subsection if no other physician or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 is available and the medical director or physician certifies this fact. If an examination is not possible because of the emergency nature of the case and because of the refusal of the person to consent to the examination, the applicant on the basis of his or her observation may determine, in accordance with the above, that emergency certification is necessary and may apply therefor. In the event that no physician or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 is available, a qualified mental health professional as defined herein who believes the person to be in need of immediate care and treatment, and one whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of psychiatric disability, may make the application for emergency certification to a facility. Application shall in all cases be made to the facility that, in the judgment of the applicant at the time of application, would impose the least restraint on the liberty of the person consistent with affording the person the care and treatment necessary and appropriate to the person’s condition. (b) Applications. An application for certification hereunder shall be in writing and filed with the facility to which admission is sought. The application shall be executed within five (5) days prior to the date of filing and shall state that it is based upon a personal observation of the prospective patient by the applicant within the five-day (5) period. It shall include a description of the applicant’s credentials and the behavior that constitutes the basis for his or her judgment that the prospective patient is in need of immediate care and treatment and that a likelihood of serious harm by reason of psychiatric disability exists, and shall include, as well, any other relevant information that may assist the admitting physician and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 at the facility to which application is made. The application shall state whether the facility, in the judgment of the applicant at the time of application, would impose the least restraint on the liberty of the person consistent with affording him or her the care and treatment necessary and appropriate to his or her condition. Whenever practicable, prior to transporting or arranging for the transporting of a prospective patient to a facility, the applicant shall telephone or otherwise communicate with the facility to describe the circumstances and known clinical history to determine whether it is the proper facility to receive the person, and to give notice of any restraint to be used or to determine whether restraint is necessary. (c) Confirmation; discharge; transfer. Within one hour after reception at a facility, the person regarding whom an application has been filed under this section shall be seen by a physician or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2. As soon as possible, but in no event later than twenty-four (24) hours after reception, a preliminary examination and evaluation of the person by a psychiatrist, a physician under the psychiatrist’s supervision, and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 shall begin. The psychiatrist, physician under the supervision of the psychiatrist, and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 conducting the preliminary examination and evaluation shall not be an applicant hereunder. The preliminary examination and evaluation shall be completed within seventy-two (72) hours from its inception by the psychiatrist, physician under the supervision of the psychiatrist, and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2. If the psychiatrist, physician under the supervision of the psychiatrist, and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 determines that the patient is not a candidate for emergency certification, the patient shall be discharged. If the psychiatrist, physician under the supervision of the psychiatrist, and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 determines that the person who is the subject of the application is in need of immediate care and treatment and is one whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of psychiatric disability, the psychiatrist, physician under the supervision of the psychiatrist, and/or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 shall confirm the admission for care and treatment under this section of the person to the facility, provided the facility is one that would impose the least restraint on the liberty of the person consistent with affording the person the care and treatment necessary and appropriate to the person’s condition and that no suitable alternatives to certification are available. If at any time the official in charge of a facility, or the official’s designee, determines that the person is not in need of immediate care and treatment, or is not one whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of psychiatric disability, or suitable alternatives to certification are available, the official shall immediately discharge the person. In addition, the official may arrange to transfer the person to an appropriate facility if the facility to which he or she has been certified is not one that imposes the least restraint on the liberty of the person consistent with affording him or her the care and treatment necessary and appropriate to his or her condition. (d) Custody. Upon the request of an applicant under this section, to be confirmed in writing, it shall be the duty of any peace officer of this state or of any governmental subdivision thereof to whom request has been made, to take into custody and immediately transport the person to the designated facility for admission thereto. (e) Ex parte court order. An applicant under this section may present a petition to any judge of the district court or any justice of the family court, in the case of a person who is the subject of an application who has not yet attained his or her eighteenth birthday, for a warrant directed to any peace officer of the state or any governmental subdivision thereof to take into custody the person who is the subject of the application and immediately transport the person to a designated facility. The application shall set forth that the person who is to be certified is in need of immediate care and treatment and the person’s continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of psychiatric disability, and the reasons why an order directing a peace officer to transport the person to a designated facility is necessary. (f) Notification of rights. No person shall be certified to a facility under the provisions of this section unless appropriate opportunity is given to apply for voluntary admission under the provisions of § 40.1-5-6 and unless the person, or a parent, guardian, or next of kin, has been informed, in writing, on a form provided by the department, by the official in charge of the facility: (1) That the person has a right to the voluntary admission; (2) That a person cannot be certified until all available alternatives to certification have been investigated and determined to be unsuitable; and (3) That the period of hospitalization or treatment in a facility cannot exceed ten (10) days under this section, except as provided in subsection (g) of this section. (g) Period of treatment. A person shall be discharged no later than ten (10) days measured from the date of his or her admission under this section, unless an application for a civil court certification has been filed and set down for a hearing under the provisions of § 40.1-5-8, or the person remains as a voluntary patient pursuant to § 40.1-5-6. R.I. GEN. LAWS § 40.1-5-7.1 (a) Any police officer may take an individual into protective custody and take or cause the person to be taken to an emergency room of any hospital, by way of emergency vehicle, if the officer has reason to believe that: (1) The individual is in need of immediate care and treatment, and is one whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of psychiatric disability if allowed to be at liberty pending examination by a licensed physician; or (2) The individual is in need of immediate assistance due to psychiatric disability and requests the assistance. (b) The officer making the determination to transport will document the reason for the decision in a police report and travel with the individual to the hospital to relay the reason for transport to the attending medical staff.

R.I. GEN. LAWS § 40.1-5-8 (a) Petitions. A verified petition may be filed in the district court, or family court in the case of a person who has not reached their eighteenth (18th) birthday, for the certification to a facility of any person who is alleged to be in need of care and treatment in a facility, and whose continued unsupervised presence in the community would create a likelihood of serious harm by reason of psychiatric disability. The petition may be filed by any person with whom the subject of the petition may reside; or at whose house the person may be; or the father or mother, husband or wife, brother or sister, or the adult child of the person; the nearest relative if none of the above are available; or the person’s guardian; or the attorney general; or the director of the department of behavioral healthcare, developmental disabilities and hospitals; or the director of the department of corrections; or the superintendent of the Rhode Island training school for youth, or the director of any facility, or the designated agent of any of the foregoing departments or facilities, whether or not the person shall have been admitted and is a patient at the time of the petition. A petition under this section shall be filed only after the petitioner has investigated what alternatives to certification are available and determined why the alternatives are not deemed suitable. (b) Contents of petition. The petition shall state that it is based upon a personal observation of the person concerned by the petitioner within a ten-day (10) period prior to filing. It shall include a description of the behavior that constitutes the basis for the petitioner’s judgment that the person concerned is in need of care and treatment and that a likelihood of serious harm by reason of psychiatric disability exists. In addition, the petitioner shall indicate what alternatives to certification are available; what alternatives have been investigated; and why the investigated alternatives are not deemed suitable. (c) Certificates and contents thereof. A petition hereunder shall be accompanied by the certificates of two (2) physicians, at least one of whom shall be a psychiatrist, or one physician and one licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2, unless the petitioner is unable to afford, or is otherwise unable to obtain, the services of a physician or physicians or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 qualified to make the certifications. The certificates shall be rendered pursuant to the provisions of § 40.1-5-5, except when the patient is a resident in a facility, the attending physician and one other physician at least one of whom shall be a psychiatrist, or the attending physician and a licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 from the facility may sign the certificates, and shall set forth that the prospective patient is in need of care and treatment in a facility and would likely benefit therefrom, and is one whose continued unsupervised presence in the community would create a likelihood of serious harm by reason of psychiatric disability together with the reasons therefor. The petitions and accompanying certificates shall be executed under penalty of perjury, but shall not require the signature of a notary public thereon. (d) Preliminary hearing. (1) Upon a determination that the petition sets forth facts constituting reasonable grounds to support certification, the court shall summon the person to appear before the court at a preliminary hearing, scheduled no later than five (5) business days from the date of filing. This hearing shall be treated as a priority on the court calendar and may be continued only for good cause shown. In default of an appearance, the court may issue a warrant directing a police officer to bring the person before the court. (2) At the preliminary hearing, the court shall serve a copy of the petition upon the person and advise the person of the nature of the proceedings and of the person’s right to counsel. If the person is unable to afford counsel, the court forthwith shall appoint the mental health advocate for him or her. If the court finds that there is no probable cause to support certification, the petition shall be dismissed, and the person shall be discharged unless the person applies for voluntary admission. However, if the court is satisfied by the testimony that there is probable cause to support certification, a final hearing shall be held not less than seven (7) days, nor more than twenty-one (21) days, after the preliminary hearing, unless continued at the request of counsel for the person, and notice of the date set down for the hearing shall be served on the person. Copies of the petition and notice of the date set down for the hearing shall also be served immediately upon the person’s nearest relatives or legal guardian, if known, and to any other person designated by the patient, in writing, to receive copies of notices. The preliminary hearing can be waived by a motion of the patient to the court if the patient is a resident of a facility. (e) Petition for examination. (1) Upon motion of either the petitioner or the person, or upon its own motion, the court may order that the person be examined by a psychiatrist appointed by the court. The examination may be conducted on an outpatient basis and the person shall have the right to the presence of counsel while it is being conducted. A report of the examination shall be furnished to the court, the petitioner, and the person and his or her counsel at least forty-eight (48) hours prior to the hearing. (2) If the petition is submitted without two (2) certificates as required under subsection (c), the petition shall be accompanied by a motion for a psychiatric examination to be ordered by the court. The motion shall be heard on the date of the preliminary hearing set by the court pursuant to subsection (d), or as soon thereafter as counsel for the subject person is engaged, appointed, and ready to proceed. The motion shall be verified or accompanied by affidavits and shall set forth facts demonstrating the efforts made to secure examination and certification pursuant to subsection (c) and shall indicate the reasons why the efforts failed. (3) After considering the motion and testimony as may be offered on the date of hearing the motion, the court may deny the application and dismiss the petition, or upon finding: (i) That there is a good cause for the failure to obtain one or more certificates in accordance with subsection (c); and (ii) That there is probable cause to substantiate the allegations of the petition, the court shall order an immediate examination by two (2) psychiatrists, or by one psychiatrist and one physician, or by one physician and one licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 pursuant to subsection (e)(1). (f) Professional assistance. A person with respect to whom a court hearing has been ordered under this section shall have, and be informed of, a right to employ a mental health professional of the person’s choice to assist the person in connection with the hearing and to testify on the person’s behalf. If the person cannot afford to engage such a professional, the court shall, on application, allow a reasonable fee for the purpose. (g) Procedure. Upon receipt of the required certificates and/or psychiatric reports as applicable hereunder, the court shall schedule the petition for final hearing unless, upon review of the reports and certificates, the court concludes that the certificates and reports do not indicate, with supporting reasons, that the person who is the subject of the petition is in need of care and treatment; that his or her unsupervised presence in the community would create a likelihood of serious harm by reason of psychiatric disability; and that all alternatives to certification have been investigated and are unsuitable, in which event the court may dismiss the petition. (h) [Deleted by P.L. 2023, ch. 99, § 1 and P.L. 2023, ch. 100, § 1.] (i) Hearing. A hearing scheduled under this section shall be conducted pursuant to the following requirements: (1) All evidence shall be presented according to the usual rules of evidence that apply in civil, non-jury cases. The subject of the proceedings shall have the right to present evidence in his or her own behalf and to cross examine all witnesses against him or her, including any physician or licensed advanced practice registered nurse (APRN) as defined in § 40.1-5-2 who has completed a certificate or filed a report as provided hereunder. The subject of the proceedings shall have the further right to subpoena witnesses and documents, the cost of such to be borne by the court where the court finds upon an application of the subject that the person cannot afford to pay for the cost of subpoenaing witnesses and documents. The court shall utilize the generally applicable rules of evidence for civil, non-jury cases to determine the admissibility of evidence at the hearing, including the qualification and requirements for expert witnesses. The authority given to APRNs to file petitions under this chapter shall not be determinative of their qualification as an expert witness. (2) A verbatim transcript or electronic recording shall be made of the hearing that shall be impounded and obtained or examined only with the consent of the subject thereof (or in the case of a person who has not yet attained their eighteenth (18th) birthday, the person’s parent, guardian, or next of kin) or by order of the court. (3) The hearing may be held at a location other than a court, including any facility where the subject may currently be a patient, where it appears to the court that holding the hearing at another location would be in the best interests of the subject thereof. (4) The burden of proceeding and the burden of proof in a hearing held pursuant to this section shall be upon the petitioner. The petitioner has the burden of demonstrating that the subject of the hearing is in need of care and treatment in a facility; is one whose continued unsupervised presence in the community would create a likelihood of serious harm by reason of psychiatric disability; and what alternatives to certification are available, what alternatives to certification were investigated, and why these alternatives were not deemed suitable. (5) The court shall render a decision within forty-eight (48) hours after the hearing is concluded. (j) Order. If the court at a final hearing finds by clear and convincing evidence that the subject of the hearing is in need of care and treatment in a facility, and is one whose continued unsupervised presence in the community would, by reason of psychiatric disability, create a likelihood of serious harm, and that all alternatives to certification have been investigated and deemed unsuitable, it shall issue an order committing the person to the custody of the director for care and treatment or to an appropriate facility. In either event, and to the extent practicable, the person shall be cared for in a facility that imposes the least restraint upon the liberty of the person consistent with affording the person the care and treatment necessary and appropriate to the person’s condition. No certification shall be made under this section unless and until full consideration has been given by the certifying court to the alternatives to in-patient care, including, but not limited to, a determination of the person’s relationship to the community and to the person’s family; of his or her employment possibilities; and of all available community resources, alternate available living arrangements, foster care, community residential facilities, nursing homes, and other convalescent facilities. A certificate ordered pursuant to this section shall be valid for a period of six (6) months from the date of the order. At the end of that period the patient shall be discharged, unless the patient is discharged prior to that time, in which case the certification shall expire on the date of the discharge. R.I. GEN. LAWS § 40.1-5-8(j). If the court at a final hearing finds by clear and convincing evidence that the subject of the hearing is in need of care and treatment in a facility, and is one whose continued unsupervised presence in the community would, by reason of mental disability, create a likelihood of serious harm, and that all alternatives to certification have been investigated and deemed unsuitable, it shall issue an order committing the person to the custody of the director for care and treatment or to an appropriate facility. R.I. GEN. LAWS § 40.1-5-2(8). "Likelihood of serious harm" means: (i) A substantial risk of physical harm to the person himself or herself as manifested by behavior evidencing serious threats of, or attempts at, suicide; (ii) A substantial risk of physical harm to other persons as manifested by behavior or threats evidencing homicidal or other violent behavior; or (iii) A substantial risk of physical harm to the mentally disabled person as manifested by behavior that has created a grave, clear, and present risk to the person’s physical health and safety. (iv) In determining whether there exists a likelihood of serious harm, the physician and the court may consider previous acts, diagnosis, words, or thoughts of the patient. If a patient has been incarcerated, or institutionalized, or in a controlled environment of any kind, the court may give great weight to such prior acts, diagnosis, words, or thoughts. R.I. GEN. LAWS § 40.1-5-2(13). “Psychiatric disability” means a mental disorder in which the capacity of a person to exercise self-control or judgment in the conduct of the person’s affairs and social relations, or to care for the person’s own personal needs, is significantly impaired.